What are the guidelines? And does lack of knowledge of the guidelines affect SSI rates?
Eleven years ago, 2013, the first of what would be 10 different Best Practice Guidelines regarding surgical site infections (SSI) following pediatric deformity surgery was issued to the broader spine surgery community in the U.S. and Europe.
While rates of SSI in spine surgery have decreased in the ensuing decade, in 2022 surgeons from the Harms Study Group and the Pediatric Spine Study Group decided to update these guidelines to incorporate the most recent evidence and experience. The newly updated guidelines also include guidance on factors associated with increased SSI risk.
At the same time, Michael Vitale, M.D., M.P.H., founder of the Project for Safety in Spine Surgery, and his group of co-authors asked the important question—how well do spine surgeons comply with these multiple sets of SSI avoidance guidelines?
Vitale and his research team collected SSI guideline compliance data from surgeons in both North America and Europe and published those results; “Evaluating compliance with the 2013 best practice guidelines for preventing surgical site infection in high-risk pediatric spine surgery,” in the January 2024 edition of Spine Deformity.
What did they find? The research group reported surprisingly high rates of compliance to these guidelines in the ensuing decade. “Our systematic review looked at 77 studies and found that neuromuscular issues, revision, longer cases, and having a comorbidity were risk factors for SSI following these procedures,” recalls Dr. Vitale, “To standardize these practices, we need a better understanding of the role of preoperative nutrition, and we need to determine if indeed a urine culture is always helpful.”
Towards that end, Dr. Vitale and his team anonymously surveyed 142 North American and European surgeons, authors and non-authors and members of various spine study groups on their adherence to best practice guidelines.
Reported Dr. Vitale to OTW: “We found that 73.7% reported high or perfect compliance.”
“While there was generally high compliance overall,” Dr. Vitale told OTW, “we found that North American surgeons, authors of the best practice guidelines and those aware of the guidelines had increased compliance. Things not associated with compliance were participation in a spine study group, years in practice, and yearly caseload.”
“I was a bit surprised at the weak correlation between best practice guidelines awareness and compliance, as well as the lack of correlation between years in practice and yearly caseload with compliance. To me this means that people are coalescing around the right things to do.”
“This year, an expert working group is well underway with a Best Practice Guideline looking at ways to optimize safety in robotic spine surgery with some 55 potential issues being examined. Come to SSS 2024 to get a sneak peek!”
The 9th Annual Safety in Spine Surgery Summit is around the corner, taking place on May 31, 2024, at The Heart Conference Center/New York-Presbyterian Hospital. According to Course Chair Michael Vitale, M.D., M.P.H., this year’s event will highlight new research and focus on robotics and enabling technologies.
To learn more about the 9th Annual Safety in Spine Surgery Summit, please visit: https://safetyinspinesurgery.com
I am not even the least bit surprised by Dr. Michael Vitale’s findings in adherence and compliance to the guidelines especially in Spine surgery. I started my career in 1989 at one of the nation’s leading pioneers in Spine surgery in Plano, Texas. I still remember at the beginning of the new yearly rotation of Fellow’s, PA’s NP’s, etc.. compliance, pre-op psychological assessment, internal medicine, CXR’s, patient education for pre and post op expectations by RN were done with every patient under going any surgery. I think with robotics coming more and more into play, the guidelines will be stricter. Patient education, compliance, and expectations are just as important as the surgical adherence pre, peri, and post surgery. There is a direct correlation with patient outcomes when the entire healthcare providers and patients are all on the same page hence; infections are avoided and positive patient outcomes are achieved.